Primum non nocere: Latin for “First, do no harm.”
It is the mantra of physicians, often attributed to Hippocrates who, around 400 B.C., advocated that physicians adhere to strict ethical standards. He may or may not have said it, but the sentiment has endured for centuries, given the deep trust we often ascribe to doctors who are charged with life and death decisions.
But, in The Age of the Microbiome, you will see that many doctors have inadvertently violated this basic tenet and have made major contributions to disruptions of the human microbiome. The consequences are far worse than a bout of diarrhea or a little stomach gurgling. Disruptions of the intestinal microbiome inflicted by prevailing practices in healthcare cause a long list of health problems, from Clostridium difficile (C diff) enterocolitis, to type 2 diabetes and obesity, to calcium oxalate kidney stones, to gout, to psychiatric disease and obsessive compulsive disorder—a partial list.
Which prescription drugs can be blamed for unhealthy disruptions of the human microbiome with major implications for health? The list grows virtually daily. It is a basic fact that, because the insights into the microbiome are emerging at blinding speed, and the FDA drug approval process did not—and still does not—require microbiome analysis, we don’t know which among the thousands of prescription drug products on the market disrupt the human microbiome. But if early experiences are any indication, prescription drugs are microbial disasters.
A recent effort from the European Molecular Biology Laboratory to identify what drugs exert effects on the microbiome found that 27% of drugs introduced adverse changes. You may take a drug for fertility, for instance, or depression, but you are really taking something that has antibiotic and microbiome-disruptive properties. Similar to the effects of the herbicide glyphosate, many drugs were most effective in reducing or eradicating beneficial microbiome species (“anticommensal” effects), least effective in reducing or eradicating unhealthy (Proteobacteria) species, the species of dysbiosis and SIBO.
So what prescription drugs do we know introduce unhealthy effects into the microbiome? Here is a partial list:
- Non-steroidal anti-inflammatory drugs (NSAIDs)—Millions of people take these common drugs such as ibuprofen, naproxen, and diclofenac. These drugs are open door invitations to the ascendance of unhealthy Proteobacteria species like E. coli and Klebsiella into the small intestines, i.e., SIBO, small intestinal bacterial overgrowth.
- Stomach acid-blocking drugs—H2-blocking drugs like ranitidine and cimetidine and, even worse, the more potent “proton pump inhibitors (PPI)” drugs like Prilosec, Protonic, and Aciphex, shift intestinal microbial species towards fecal Proteobacteria and, like NSAIDs, invite them to ascend up the ileum, jejunum, duodenum, and stomach. PPIs also increase risk for Clostridium difficile enterocolitis. Part of this effect is due to reduced stomach acid, but PPIs also exert direct antibacterial effects, also.
- Statin cholesterol drugs—We’ve known for some years that taking a statin cholesterol drug increases risk for type 2 diabetes by 30-50%. Doctors dismiss this by saying “The small risk of type 2 diabetes is outweighed by the reduction in cardiovascular risk,” not realizing that they had drunk the Big Pharma Kool-Aid manipulation of data that means that claims such as “Statin X reduces risk of heart attack by 36%” really means “Statin X reduces risk of heart attack by up to 1% over 5 years”—hardly at all. The changes introduced into the microbiome by statin cholesterol drugs makes your microbiome look like the microbiome of someone who is an obese, type 2 diabetic—even if you are slender, active, and non-diabetic. It means that the microbiome changes introduced by a statin agent push your physiology towards that of becoming an obese type 2 diabetic.
- Antibiotics—This is obvious, but the changes can be long-lasting and permanent. While there are times when we should be grateful for the availability of an antibiotic, there is massive overuse of antibiotics that achieve nothing while disrupting the intestinal microbiome. If you lose bacterial species during a course of, say, antibiotics for the flu or viral respiratory illness “just in case” it converts to bacterial pneumonia, you cannot regain these species. What if the species you lose are “keystone” species, i.e., species that are crucial for the health and proliferation of numerous other desirable species? You can experience profound and irretrievable disruptions in the composition of the intestinal microbome.
- “Atypical” antipsychotics—These are newer agents, such as clozapine and olanzapine, to treat schizophrenia and bipolar illness that are replacing traditional antipsychotic drugs. Atypical antipsychotics are commonly associated with causing type 2 diabetes and weight gain that may result from shifts in microbiome composition, including reductions in species diversity and reduction in the keystone species, Akkermansia.
Microbiome-disruptive effects have also been described for the immunosuppressive drug azathioprine, the antidepressant venlafaxine, anti-inflammatory drugs mesalazine and aminosalicylate, and calcium channel blockers commonly prescribed for hypertension and heart rhythm disorders.
What about drugs that exert beneficial microbiome effects, even if such beneficial effects were not appreciated during drug development or FDA approval? I’m aware of only one such example: metformin. This common drug prescribed to reduce blood sugar in people with type 2 diabetes exerts much of its effects via changes in the microbiome.
Primum non nocere? As you can see, this mantra is about as meaningless as “Everything in moderation” or “Calories are calories,” patent falsehoods that are repeated over and over again by those offering dietary and health advice because, you know, the more often you repeat a falsehood, the more people will believe it’s true. Prescription drugs are potent disrupters of the intestinal microbiome with substantial implications for mental and physical health.
Bottom line: Minimize your reliance on potential microbiome-disruptive prescription drugs. If you have an autoimmune condition, obesity, type 2 diabetes, ulcerative colitis, psoriasis, or so many other common chronic conditions that plague modern humans, don’t first look to the doctor and healthcare system for answers; look to the microbiome. Look for growing wisdom right here in the Wheat Belly Blog. If you want to take your knowledge and healthy strategies even further, consider joining my Undoctored Inner Circle community where we discuss such issues face-to-face and where membership dues go towards program development, funding research, and paying staff.